Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 34.014338 | OH |
NPI | 1093246902 |
---|---|
Provider Name | Dr. William Martin Fogarty IV |
First Address | Grove City, OH 43123-4033 |
Second Address | Columbus, OH 43205-2639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 27/06/2020 |